Musings in the life of an internist, cardiologist and cardiac electrophysiologist.

Sunday, March 30, 2008

First, Blame the Patient

Here's a prescription for health care reform in case some of us are not aware of the fete accompli that we have reached in the policy world with the upcoming election - here's a quick summary of what's coming:

6. Spend lots and lots of money on "new media consultants" to be sure the blog-o-sphere learns of this website (h/t: Thanks, Chris)

7. Pat yourself on the back for defining "the problem."

We appreciate the detailed spreadsheets of costs provided by the Partnership to Fight Chronic Disease. Given their apparently extensive talent bank and funding for this type of analysis, we look forward to seeing comparable line-item analyses for the costs of ever-burgeoning healthcare bureaucracy.

It baffles me that as acute disease has decreased as a cause of death, people look at the "growth" of deaths due to chronic disease. All people die of something. N=everybody. If the portion of N that dies of acute disease goes down, the portion dying of something else, eg, chronic disease, goes up. And the more learned about treating chronic diseases like hypertension, the more people will have them for a substantial period.

Why does anyone need the blame? I mean, why can't people just get sick? I understand that there are some things that can be done with some illnesses, I'm not saying no one is *ever* to blame. Just, sometimes people get sick. They can't be helped, the fact that they got the illness can't be helped, it just happens.

---------- Overweight rates have been climbing over the past few decades among children. About 9 million (or roughly one in six kids ages 6–19) were overweight in 2004 – more than triple the number of overweight children in 1980. ----------

But does the author consider, at a minimum -

---------- In 1985 a consensus conference convened by the National Institutes of Health (NIH) recommended that men and women be considered “overweight” at BMIs of 27.8 and 27.3, respectively. In 1996 an NIH-sponsored review of the literature found that “increased mortality typically was not evident until well beyond a BMI level of 30.” Yet two years later [1998], the NIH yielded to a World Health Organization recommendation that “overweight” be defined downward to a BMI of 25, with 30 or more qualifying as “obese." ----------

And while I certainly accept that tobacco use can have profound health consequences, I am less sure about diet and exercise regimes - most seem extreme, and dieting ineffective.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.